Dietary Considerations in Coumadin Patients

Coumadin (generic name warfarin) acts by impairing the function of Vitamin K. Dietary intake of Vitamin K will counteract the medicinal purpose of Coumadin Intake of large amounts of Vitamin K can diminish the effect of Coumadin, permitting the blood to clot. Likewise, if you eat too little vitamin K, it may cause your blood to become too thin. It is difficult for most patients to avoid all Vitamin K containing foods. A prudent alternative is to be sure that you eat the same amount of Vitamin K on a regular basis. As an example, the following are foods known to be high in Vitamin K Kale Broccoli Cauliflower Brussels sprouts Beef, pork, or chicken livers Spinach Turnip greens Chick peas Green tea Soybean oil

Soy protein products (including tofu) Vitamins A & E (large doses) If your regular diet already contains these food items, you dont need to eliminate these foods from your diet. Consistency in your daily eating pattern is the key! Your medication can be adjusted to the amount of vitamin K typically in your diet. If you suddenly increase or decrease the amount of vitamin K in your diet, your medication will not work properly. II. What is the best diet to follow while I am on Coumadin? A. A healthy, low fat diet following the Food Guide Pyramid is the best diet to follow. B. It is important for you to keep the vitamin K content of your diet consistent. The amount of vitamin K you eat affects the amount of Coumadin you require. C. Be sure to tell your doctor if you change your diet. The medication will need to be adjusted to the amount of vitamin K in your diet. III. Does this mean I should avoid foods with a lot of vitamin K? Absolutely not! Some foods that are high in vitamin K (i.e. leafy, green vegetables, broccoli, and cauliflower) can contribute to a healthy diet. Your efforts should be focused on keeping your intake of vitamin K consistent from day to day. The first step is to evaluate your typical intake of vitamin K foods by reviewing the food list in this packet. IV. Does cooking, freezing, or drying foods change how much vitamin K is in them? Although there is little information about the effects of cooking, freezing, or drying on the vitamin K content of foods, it appears that the vitamin K content of cooked, frozen, or dried foods is about the same as fresh foods. V. What to do from here. Evaluate your typical vitamin K intake by reviewing the food list provided. The list contains foods that are known to be high in vitamin K, as well as a few others that are not very high, but are often asked about by Coumadin patients. If you do not see a particular food on the list, it most likely contains very little vitamin K, however, be sure investigate a given food if you are concerned.

VI. Using the Vitamin K food list: A. First, review the list to find foods that you are presently eating. Each list contains the same information. The column on the left organizes foods from the highest vitamin K content to lowest, while the column on the right is in alphabetical order. Observe the amount of vitamin K contained in the foods you eat. If you typically eat a larger portion than what is listed, be sure to increase the vitamin K value proportionally. (i.e. there is 40ug of vitamin K in cup of lettuce, but you eat 2 cups worth in your salad, so you would actually have 160ug of vitamin K in total). Add up the total amount of vitamin K that you typically consume in a day. Whatever it may be, 100, 200, 300, 400ug, etc., your job is to keep this daily intake as consistent as possible. By selecting combinations of foods, and/or adjusting portion sizes you should be able to consume about the same amount of vitamin K each day. CAUTION -: the following should be taken only with your physicians approval, because they also thin your blood, thus increasing the effect of your medication: alcohol, garlic pills, fish oil capsules, vitamin E. Vitamin K tablets can also interfere with your Coumadin medication. Be sure to get your physicians approval, if you take vitamin K tablets or a multi-vitamin pill with vitamin K included.

(Highest to lowest) Food Item Seaweed (Nori) Turnip greens Collard greens Spinach Brussels sprouts Kale Swiss chard Green tea Parsley Green scallion Broccoli Cauliflower Cabbage Liver (beef, pork, chicken) Soybean oil Endive Avocado Coriander Asparagus Mustard greens Green tomato Watercress Artichoke Lettuce Okra Soybeans Green beans Nettle leaves Red tomato Garbanzo beans Green peas Alfalfa sprouts Celery Green pepper Tofu Lima beans Portion Size 2 sheets cup cup cup cup cup cup cup cup cup cup cup 3.5 oz 1 Tbsp cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup Vit. K (ug) 511 470 440 360 289 270 249 162 155 113 96 Food Item Alfalfa sprouts Artichoke Asparagus Avocado Broccoli Brussels sprouts Cabbage Cauliflower Celery Collard greens Coriander

(Alphabetical) Portion Size cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup cup 1 oz (leaves)** cup cup cup cup cup cup cup cup cup 2 sheets 1 Tbsp cup cup cup cup cup cup Vit. K (ug) 16 42 51 57 113 289 80-100 96 16 440 52 6 69 22 33 22 5 155 199 50 270 40 2 80-100 51 31 40 162 25 511 76 34 360 249 2.5 470 42

1 oz (leaves) ** 199

Cucumber (with peel)

80-100 Endive 80-100 Garbanzo beans 76 69 57 52 51 51 50 42 42 40 40 34 33 31 25 22 22 16 16 6 5 2.5 2 Green beans Green peas Green pepper Green scallion Green tea Green tomato Kale Lettuce Lima beans Mustard greens Nettle leaves Okra Parsley Red tomato Seaweed (Nori) Soybean oil Soybeans Spinach Swiss chard Tofu Turnip greens Watercress

Liver (beef, pork, chicken) 3.5 oz

Cucumber (sliced with peel) cup

Ensure 8 oz can 18 ** Current analytical findings indicate that the brew form green tea leaves has negligible vitamin K content.